To the Editor We read with great interest the article by Cooper et al.¹ The study revealed that 28.0% of patients diagnosed with biopsy-proven oral cavity carcinoma in situ exhibited occult invasive disease on definitive resection. Although most of these patients have a high survival rate due to a low disease T stage, the patients who underwent surgical resection experienced significantly superior survival outcomes compared with their nonsurgical counterparts. This underscores the importance of considering this type of treatment over others.

In our opinion, although a randomized clinical trial comparing incisional biopsy with excisional biopsy is still needed, it is necessary to completely remove the lesion with an excisional biopsy. This is because the heterogeneity of the lesion may cause the invasiveness of the neoplasm to go unrecognized, especially in subsites with a higher rate of occult invasive disease. Additionally, the risk of blood dissemination due to incomplete and nonradical incisional biopsy should be considered.²